Dr. Bill Elliott: Calming kids' behavior with regular bedtime

IF YOUR CHILD is having behavioral problems at school, there is one simple thing you can do to help — make sure little Johnny or Janie goes to bed at the same time every night.

It turns out that children who have regular bedtimes have fewer behavioral problems in school while kids with irregular bedtimes have significantly more behavioral issues. These are the findings of a major new study published last week in the prestigious medical journal Pediatrics.

The behavior of young children is affected by their environment, and it is not surprising that family routines and nurturing activities have definite influences on their behavior. But according to this new study, sleep schedules in childhood may be one of the most important determinants of childhood behavior. Erratic sleep schedules have significant psychological and physical effects on kids that can last for years, even into adulthood.

Pediatricians have known for years that disrupted sleep and behavioral problems are linked, but it has been unclear whether erratic sleep patterns cause behavioral problems or visa versa.

In this new study, researchers in the England sought to answer three questions:

 Are bedtime schedules associated with behavioral difficulties?

 Do the effects of bed time schedules build up over early childhood?

 Are changes in bedtime schedules linked to changes in children's behavior?

Data was gathered from more than 10,000 children in a project called that UK Millennium Cohort Study with bedtime data collected from families when the children were 3, 5 and 7 years old. Bedtime schedules were linked to behavioral difficulty scores as rated by mothers and teachers.

The analysis clearly showed that children with nonregular bedtimes had more behavioral difficulties. And the behavior worsened as irregular bedtimes increased throughout childhood. The older the child was with erratic bedtimes, the worse the behavior.

But encouragingly, children who went from irregular bed time schedules to regular bedtime schedules showed significant improvements in behavioral scores. There was a marked improvement in behavior as bedtime schedule is improved between ages 3 and 7, but an even bigger improvement was seen if regular bedtimes were initiated between ages 5 and 7.

The investigators concluded that regular bedtimes during early childhood have an important influence on children's behavior. They even suggest that interventions aimed at supporting family routines, including regular bedtimes, could have "important impacts on health throughout life."

This isn't the only research that has suggested that children crave routines in their schedules. Other studies have shown that regular meals, reading to a child on a regular basis, and avoiding excess TV are all determinants of a child's behavior.

But sleep patterns are particularly powerful. Children with irregular bedtimes tend to be more sleep deprived compared with children with regular bedtimes. Irregular sleep patterns also throw circadian rhythms out of balance. Combine sleep deprivation with disrupted daily rhythms and behavioral problems are bound to worsen, especially if irregular sleep occurs day after day. As children age into adolescence, irregular sleep is highly associated with low self-esteem and depression.

The best news of this study is the reversibility of the sleep effect. Getting kids back on a regular sleep schedule improves their behavior and makes them healthier.

Sleep specialists often say that we humans crave consistency in our daily routine. Those of us that sleep the best tend to go to bed at the same time and get up at the same time. This is particularly important for our children, especially in a world with so many distractions.

It is important to turn off the TV, the computer, the smartphone, the iPad and the Xbox. Let kids settle down and get them to bed at the same time every night. They will be healthier as kids and adolescents, and even as adults.

Dr. Bill Elliott is an internist at Kaiser Novato and an assistant clinical professor of medicine at UCSF. His column appears every third Monday.